Chewing on the basics of cardiac cuisine. First lesson: Sodium 101.

Ever since I got over my phase of anorexia in my early twenties, I thought I was following a healthy diet.  I ate a lot of vegetables, I did not eat much in the way of fried foods, and I hardly ever ate calorie laden deserts.  But even with my good eating habits, I still had to make some significant changes to my diet once I became a heart failure patient.

If you have read this blog before, you are well aware (and probably sick of the fact) that I had to give up my addiction to salt.  I also have to keep to a heart healthy diet of low fat.  This still gives me a lot of options.  But there are some basic rules that I had to learn early on in the process as I was making over my diet choices to reduce salt.
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Avoid the two C’s:  Condiments and convenience.  Condiments are things like ketchup, mustard, soy sauce, barbecue sauce, salad dressing and hot sauce.  These are things that one might just shake or spread on a sandwich, a burger, ribs, Chinese food or a healthy green salad without even thinking of the consequences. 

And what might those consequences be, you ask?  Is it the calories?  Probably not a lot of calories in things like soy sauce and mustard, likely a lot more in salad dressing.  But there is a significant amount of sodium lurking in each of these condiments – even if you get low-calorie salad dressing!   For the most part, I have learned to avoid condiments or to use them very sparingly.

Convenience foods are the food items that manufacturers market to save you time.  You know, things like that are faster to cook like soup ingredients in a box or a can, instant cereal, a gravy mix, pasta and rice mixes, etc.   Because these foods are easier to prepare when you have a busy schedule, they may cost a little more than fresh food or food that you have to spend more time and steps preparing. 

But there may be an even higher price.  Even though these foods are much easier to cook and serve, they may include an unhealthy price tag.  Some of these foods are highly processed and include a fair amount of preservatives such as sodium.  Foods such as this are found in either the canned food aisle or the frozen food aisle.  This doesn’t mean that you cannot purchase foods in a can or from the freezer.  But you need to take a look at the sodium content.  If it is too high and there is not an alternative product that contains less sodium, then you might be wise to skip this purchase.

One way that you can avoid the sodium trap is to make sure that you diet contains a lot of fresh and colorful choices.  By this, I mean that you can find a lot of good choices in the fresh produce aisle of your grocery store, ranging from colors like red, green, yellow, orange, purple, beige, etc.  While there may be a small amount of sodium in produce, it is really a very very small amount.  There are so many wonderful choices that taste good when you cook or steam them and you don’t need to add salt.  You can add flavor by using herbs in your cooking instead.

Examining the sodium content can be a little confusing unless you understand that there is a difference between the terms low sodium, sodium free and no salt.  Here is a chart from the Mayo Clinic website breaking down the various sodium choices:

Best choices

• Sodium-free or salt-free. Each serving in this product contains less than 5 mg of sodium.
• Very low sodium. Each serving contains 35 mg of sodium or less.
• Low sodium. Each serving contains 140 mg of sodium or less.

What the other sodium label claims mean

• Reduced or less sodium. The product contains at least 25 percent less sodium than the regular version.
• Lite or light in sodium. The sodium content has been reduced by at least 50 percent from the regular version.
• Unsalted or no salt added. No salt is added during processing of a food that normally contains salt. However, some foods with these labels may still be high in sodium because some of the ingredients may be high in sodium.

What about salt substitutes?    If you take a look at the spice aisle, you will find that there are a number of bottles of things that are labeled salt substitutes.  I think these items can be useful for some but not all people.  For example, the British Heart Foundations advises that some salt substitutes can be very high in potassium and are not recommended if you have heart failure.  The foundation suggests it would be better just to try and gradually get used to the different taste of your food without salt.  I can vouch for that statement.  I used to think food would be awful without salt, but I have lived on a salt reduced diet for over three years and food tastes really good.

I used to like some of the boxed rice and couscous side dishes that were on the market.  If you look at the side of the box, the sodium content is extremely high.  However some of them come with a separate seasoning packet.  The brands that have a separate packet are the only one that I currently use.  What I do is open the packet and cut the seasoning to an amount that will fit into my sodium budget.  This will provide a little bit of flavor but not the sodium hit.

I am including below links to an American Heart Association website article on sodium as well as an infographic called the Salty Six.  You might be surprised by the first item in the graphic:  Bread.  Most people would doubt that there is sodium in bread because it does not taste salty.  But there is.  It is not so much that one serving of bread would put you over your sodium allowance.  It is the number of times that bread appears in a diet throughout the day – toast for breakfast, sandwiches for lunch, rolls for dinner.  In other words, it is the accumulation of bread products that can cause the sodium content to rise to an unhealthy level. 

I really like the salty six infographic because it has a treasure of information.  Scroll down the infographic and you will see a second infographic called “7 Salty Sodium Myths Busted”.  You should take a look at this graphic as well.

Getting back to the subject of sodium in bread, I want you to think back to restaurant meals with friends.  How many times as you are chatting and waiting for the salad and entrée to come do you reach for the bread basket?  I have observed that it is a mindless reflex for most people to put a piece of bread in their mouth and to take a sip of from the water glass.   But for patients who are on both sodium and fluid restrictions, “mindful” is the attitude you need to adopt when eating in restaurants.

In fact, the whole restaurant experience now has to be very mindful.  This is the case whether it is a fast food location, a casual dining location, a five star restaurant, or even dining in one of the many locations on a cruise ship.  While I have noticed that some casual and fast food restaurants have nutrition guides on-line where you can check nutritional content, this is something that you will not be likely to find with respect to conventional restaurants.  So you need to use common sense.

I always pass up things like soup in restaurants because they tend to have a high sodium content.  Salads are a safer bet if:  (1) you ask for the dressing to be put on the side, and any protein like chicken or fish or beef is grilled, and you can ask that the chef not put any salt on it.  Then when you actually get the salad, take the salad dressing and put it aside and only use it very sparingly, if at all on the salad.   I have learned over time that if the ingredients in the salad are good, you really won’t need dressing.      

Oh, and when you’re at home, take the salt shaker off your dining table.  You don’t need to be undermining all your efforts to find low sodium choices if you are adding salt at the table!  And let me close something on the American Heart Association website regarding Common Myths about Sodium.  The myth is:  “I use kosher or sea salt when I cook instead of regular table salt. They are low-sodium alternatives.”  Here is the American Heart Association response:  Chemically, kosher salt and sea salt are the same as table salt — 40 percent sodium— and count the same toward total sodium consumption. Table salt is a combination of the two minerals sodium (Na) and chloride (Cl).   So do not fall for this sodium trap. 

The bottom line is that you should give the flavor of food a chance without overloading it with salt.  I think you’ll be pleasantly surprised at how good your food will take minus a lot of salt!

https://healthyforgood.heart.org/eat-smart/infographics/salty-six-infographic

​  https://healthyforgood.heart.org/eat-smart/articles/can-processed-foods-be-part-of-a-healthy-diet